A meta-analysis of 13,132 patient records from the Early Breast Cancer Trialists Collaborative Group (EBCTCG) finds that nodal irradiation reduced long-term breast cancer recurrence, cancer-specific mortality and overall mortality. Researchers found that these benefits were specific to women who enrolled in clinical trials within the last several decades, however. In older trials examined in the meta-analysis—those that began 1961-1978—nodal therapy did not impact recurrence or breast cancer mortality but increased the chance of non-cancer mortality.
The different outcomes between modern and older trials reflect how radiation therapy has become substantially more precise over time, allowing more of the target dose to reach the lymph nodes rather than scatter to the heart. Researchers also compared findings for different regions of lymph nodes (axilla, supraclavicular fossa, internal mammary chain) but found no significant difference in recurrence rates.
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RAPID: A randomized trial of accelerated partial breast irradiation using 3-dimensional conformal radiotherapy (3-D CRT) (abstract GS4-03)
Key takeaway: Accelerated radiation therapy with 3-D CRT to just part of the breast is non-inferior to traditional radiation to the whole breast.
A new report from the multi-center, randomized RAPID trial demonstrates that accelerated partial breast irradiation (APBI) with 3-D CRT is not inferior to standard treatment with whole breast irradiation (WBI) following breast-conserving surgery for early-stage breast cancer. Patients in both arms of the trial experienced similarly low rates of tumor recurrence in the treated breast at 5 and 8 years following treatment.
APBI is a highly localized alternative to WBI where patients receive larger individual doses of radiation across fewer treatment sessions. Treatment with APBI typically takes a week or less, compared to three to six weeks for WBI. In this trial of 2,135 patients enrolled in three different countries, APBI was associated with less short-term toxicity but more long-term cosmesis and normal tissue side effects.
Dose escalated simultaneous integrated boost radiotherapy for women treated by breast conservation surgery for early breast cancer: 3-year adverse effects in the IMPORT HIGH trial (abstract GS4-05)
Key takeaway: A radiation therapy regimen of dose-escalated, simultaneous integrated boost is safe and well-tolerated for early-stage breast cancer.
A report from the multi-center phase III IMPORT HIGH trial shows that patients experienced similar adverse events following radiation therapy involving a dose-escalated simultaneous integrated boost as they did with standard treatment of whole breast radiation followed by a sequential boost. Three-year rates of moderate/severe long-term effects were low and generally similar across study groups, based on analysis of 2,617 women who received radiation following breast-conserving surgery for early-stage disease.
